Title: Application of ICG fluorescence staining by intraoperative laparoscopic ultrasound guiding portal branch puncture approach in anatomical segmentectomy
Abstract: Objective
To investigate the safety and feasibility of indocyanine green (ICG) fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture approach in anatomical segmentectomy of the liver.
Methods
The clinical data of 22 patients with malignant liver diseases underwent anatomical segmentectomy between February 2018 and May 2018 were retrospectively analyzed. ICG 0.125~0.250 mg was directly injected into the portal branches supplying blood flow to the tumor-bearing hepatic segment, after puncturing of the target portal branch under intraoperative laparoscopic ultrasound guidance in all patients. The fluorescence imaging system (Pinpoint) was used for the resection procedure. Observation indicators: intraoperative conditions (tumor diameter, success rate of portal branches puncture, success rate of staining the target hepatic segment, intraoperative complications, time of operation, volume of intraoperative blood loss, blood transfusion, and transit of laparotomy). Postoperative conditions: postoperative complications, and length of hospital stay.
Results
Twenty-two patients with liver tumors were all performed anatomical hepatectomy assisted by laparoscopic ultrasound guiding ICG injection for liver segment staining. All the liver tumors were hepatocellular carcinoma. ①Intraoperative conditions: The portal branches puncture successful rate was 100% (22/22). Eighteen patients achieved expected effect of ICG fluorescence staining, with a satisfaction rate of 81.8% (18/22) and 4 failed to get expected effect, including 2 with uneven dying, and 2 with adjacent hepatic segmental staining induced to unclear boundary. No complication such as allergy occurred in all patients after ICG injection. The mean operation time was (209±89)min(range: 97~325 min) and the target portal branches ICG puncture injection time under intraoperative laparoscopic ultrasound guidance was (11 ± 5)min (range 3-25 min). There was no intraoperative blood transfusion or transit of laparotomy.Average tumor diameter was (3.9±1.3)cm(range: 2.2-7.0 cm). ②Postoperative conditions of 22 patients, 4 with grade Ⅰ-Ⅱ of Clavien-Dindo classification were improved by drug treatments (1 with deep venous thrombosis of the lower extremities and 3 with pleural effusion), no patient had grade Ⅲ and above complications, and no perioperative death occurred. Average duration of hospital stay was (7±2) days in 22 patients (range: 5.0-14.0 days).
Conclusions
ICG fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture, obtains accurate and lasting fluorescence markers on the liver surface and inside the parenchyma. ICG staining guides the selection of liver section in the operation of liver in real time, and helps surgeons to perform laparoscopic anatomical segmentectomy of the liver.
Key words:
Ultrasonic guidance; Hepatectomy; Laparoscopes; Fluorescence imaging; Indocyanine green
Publication Year: 2019
Publication Date: 2019-08-25
Language: en
Type: article
Access and Citation
AI Researcher Chatbot
Get quick answers to your questions about the article from our AI researcher chatbot